Without accessible, simple, and affordable testing sites, don’t expect people to get tested
Long wait times, confusing insurance information, expensive tests, and a very real curiosity about to how to get tested if you rely on public transportation. These are just a few of the critical issues around testing that contribute to the COVID-19 pandemic that shows no signs of slowing in the United States.
While measures like community mask mandates, social distancing, and the closure of certain high-congregation areas are essential to slowing and preventing the spread of COVID, testing is equally critical and yet one of the least efficient processes in many areas around the U.S. Without following these basic guidelines, it is unlikely that those who need a COVID test will be able to receive one.
1- Do not require payment or insurance.
We live in a country of uninsured and underinsured individuals. Even for insured folks, given the economic hardships that many Americans are facing, testing can be too expensive. Many testing centers have ambiguous information about which insurance companies are accepting payment, even though that should be easy enough to list on their informational website. This is not a normal illness. This should not be treated like a normal illness. To eradicate this illness, testing needs to be affordable, and especially right now, ‘affordable’ for many means free.
2- Do not require referrals.
During a pandemic, a great way to deter a sick person from getting tested is to give that person multiple hoops to jump through just to get a confirmation that they’re sick. Symptomatic folks are likely to be exhausted and potentially feverish. It does not take a primary care physician to let them know, and it could be additionally hazardous for that person to need an in-person visit, plus it incurs additional expenses and potential accessibility issues. Referrals in general are a piece of healthcare that I personally believe needs to truly be rethought, but especially now, this added step is a deterrent to getting tested.
3- Do not require close contacts.
Community spread is very real. Across the U.S., cases are beginning to sharply increase again. Many individuals do not know how they could have gotten COVID, citing strict social distancing, mask wearing, and excessive cleaning and hand washing. And then there are the asymptomatic spreaders to consider. Requiring close contacts to have a test or to have a test covered by insurance is, again, a deterrent to getting tested.
4- Do not require symptoms.
Asymptomatic individuals with COVID are still able to spread the illness. Additionally, the list of symptoms for COVID is now so long that perhaps someone needing a test does not know that fatigue or sore throat might be their only initial symptoms. When I was first ill with COVID, my only symptom was an extremely mild sore throat, which at the time was not considered an actual symptom. The only reason I got tested right away was because I knew that my one close contact had symptoms and a sick family. The sore throat lingered for a whole week until extreme fatigue set in and the coughing started, and finally I was unable to breathe properly. But as far as we know, a person is contagious from two days before feeling their first symptom. Requiring symptoms even for those who are truly asymptomatic is a deterrent, especially for those impacted by health insurance requirements who will only be covered if experiencing symptoms.
5- Make testing centers physically accessible.
Going to get tested without a personal vehicle but also without endangering anyone else means that ride shares and public transportation are out of the question. Walking is a possibility, assuming that a testing center that is affordable and all of the other needs of the individual are also met. But it is highly unlikely that a person who is sick is going to walk for an extended period of time to go get tested, especially as colder weather sets in and even becomes extremely harsh in many parts of the country. Without a sufficient amount of testing centers that can be easily accessed by anyone needing a test, we can expect that people will not get tested.
6- Make more tests and testing centers available.
To truly combat this pandemic, we need more tests. Extensive, available testing can only be achieved if all of the aforementioned goals are met. Testing helps us to understand the spread of the illness, hotspots, and of course, if we need to isolate and keep our loved ones and community members safe. Efficient testing reduces community spread. The U.S. has largely been failing at this.
Aside from more tests, we need more testing centers to be able to reach the most people. Waiting outside forever in the cold is a deterrent, and that happens because not enough centers are available for the demand. Mobile units could be established to relieve some of the burden on testing centers that are open, visiting various zip codes on various corners on a regular schedule. Extending hours of various testing locations could also contribute to shorter wait times, although it adds an additional burden to healthcare workers who have been tirelessly working this pandemic for months.
At-home tests are becoming more accessible, but it’s unlikely that a person will think to get an at-home test until they’re feeling sick or worried that they were exposed. Aside from other concerns about at-home tests, it’s an option that needs to be considered, as they could be extremely helpful for families to have on hand.